347 - Time to Clinical Stability in Children with Community-Acquired Pneumonia

Poster Number: 347
Publication Number: 347.204

Madeline R. Field, Medical College of Wisconsin, Wauwatosa, WI, United States; Lilliam Ambroggio, Children's Hospital Colorado, Aurora, CO, United States; Douglas Lorenz, University of Louisville, Louisville, KY, United States; Samir S. Shah, Journal of Hospital Medicine, Cincinnati, OH, United States; Richard M. Ruddy, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Todd A. Florin, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Objective outcomes for pediatric community-acquired pneumonia (CAP) are limited. Time to clinical stability (TCS) is a commonly used outcome in adults with CAP, yet few studies have applied TCS to children.

Objective: To describe TCS in children with suspected CAP and identify factors associated with reaching early clinical stability.

Design/Methods: Prospective cohort study of children with suspected CAP presenting to an emergency department from July 2013 to May 2017. Children 3 months to 18 years old who were hospitalized with lower respiratory signs or symptoms and had a chest radiograph for clinical concern for CAP were included.  We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. TCS parameters included temperature, heart rate, respiratory rate, and hypoxia with use of supplemental oxygen. TCS was defined as time to normalization of parameters from time of admission. We examined various combinations of TCS parameters.  We also evaluated the association of TCS with severity, and clinical factors at time of ED visit associated with earlier TCS (within first 24 hours after hospitalization). 

Results: Of the 1142 enrolled children, 571 (50%) were hospitalized. The median age was 3.3 years (interquartile range [IQR], 1.4, 4.9 years). The median length of stay was 35.5 hours (IQR 20.4, 49.7). At least 1 parameter was abnormal in 187 (32.7%) children at discharge and no child had >3 abnormal discharge parameters (Table 1). Of children 3 months – 1 year old, 90 (93%) had all 4 parameters stable at discharge vs. 21 (49%) of 12-18 year olds. The median TCS for each of the parameters was < 24 hours. TCS increased with disease severity and length of stay (Figure), with a gap between TCS and LOS for children with mild-moderate outcomes. Younger age, shorter illness duration, no vomiting, lower temperature, no decreased breath sounds, and normal capillary refill were associated with early clinical stability (Table 2). Children discharged with unstable parameters were not more likely to revisit after discharge.Conclusion(s): Our study demonstrates that a TCS outcome consisting of routinely collected physiologic parameters may be useful for objectively assessing disease recovery and clinical readiness for discharge among younger children hospitalized with CAP. Given the gap in TCS and LOS, TCS may decrease LOS if implemented to guide discharge decisions. Additionally, clinicians can consider factors associated with earlier TCS when making management decisions.
Madeline Field CVMadeline Field CV January 2022.pdf
Figure: Time to clinical stability (TCS) and length of stay (LOS) according to disease severity among children hospitalized with community-acquired pneumonia.Y-axis represents TCS (for RR, HR, Temp, and Oxy) or LOS in hours. The median TCS is represented by the middle line in each box. The lower and upper borders of the box represent the 25th and 75th percentiles, respectively.